Regular exercise may slow the progression of coronary heart disease and reduce
coronary risk better than angioplasty does in many cases, a study published in
March 2004 suggests.

German researchers assigned 101 men with coronary heart disease either to ride
an exercise bicycle 20 minutes a day and do an hour-long aerobic workout once a
week or to undergo angioplasty, in which surgeons use a balloon to open a blocked
coronary artery and insert a stent. One year later, the reductions in chest pain, or
angina, were similar in both groups. Moreover, the exercisers had better workout
capacity and experienced fewer cardiovascular events, including heart attack, stroke,
and hospitalization for worsening angina.

That doesn’t mean exercise should necessarily replace angioplasty for heart
patients. The study, published in the journal Circulation, was small and included only
patients with mild-to-moderate disease; in theory, angioplasty might have proved
superior to exercise in people with more disabling angina.

Still, the findings underscore the critical value of carefully supervised exercise for
all coronary patients. Equally important, the results suggest that exercise alone may
be enough to adequately relieve pain, improve functioning, and possibly reduce
cardiovascular risk in people who have mild heart symptoms. Angioplasty––or bypass
surgery in more serious cases––may still be needed when medication and exercise
cannot control angina. _

Avoiding runners’ injuries
If you run frequently, watch for these warning signs: pain when standing or moving; redness, swelling, and warmth in the lower leg after running; tenderness to pressure; and a crunchy feeling in the muscles, mainly at the start and end of exercise. Those may signal an overuse injury, such as tiny tendon tears, muscle strains, shinsplints (inflammation of the membrane around the shin bone), stress fractures (tiny cracks) of the shin, and inflammation under the heel (plantar fasciitis) or behind and above the heel (Achilles tendinitis).

Your best injury protection is to avoid putting excessive demands on your lower body. Favor slower, longer jogs over faster, shorter runs. Alternate running with other workouts and try to run on soft surfaces. Increase exercise intensity, frequency, and duration by no more than 10 percent per week. Choose flexible, comfortable shoes, with adequate cushioning and support, and replace them regularly. If your feet overpronate, or roll inward excessively, consider orthotics.
If symptoms arise, substitute another activity that doesn’t hurt until the discomfort disappears. Short-term use of a pain reliever can help quell the aching.

Health benefits of weight loss vs. exercise
Including exercise in a weight-loss program substantially boosts the benefits of slimming down––and sharply reduces the risks of being overweight even if you don’t shed pounds, research has shown.

In a four-year multicenter study published in September 2004 in the Journal of the American Medical Association (JAMA), researchers followed more than 900 women at risk of heart disease. Excess weight was not related to the chance of developing clogged coronary arteries or of having a heart attack or stroke. But the risk of such events rose steadily as physical fitness declined––an increase of 46 percent in women with below-normal fitness compared with the others.

However, excess weight, regardless of exercise, can still be risky. In a large Harvard University study of women, reported in the same issue of JAMA, being overweight predicted the development of type 2 diabetes far better than did lack of exercise. An even larger, longer Harvard study, published in December 2004, found that physically fit overweight women had nearly twice the risk of death of similarly fit but lean women—though still considerably less risk than inactive, overweight women.

If you’re overweight, focus on both exercise and weight loss as a combined goal. In addition to working out, try to limit calories, in part by favoring fruits, vegetables, and whole grains. That approach can provide substantial health benefits and helps take the focus off the scale as the sole marker of success, a potentially discouraging strategy. _